Guns Don't Kill People – Doctors Kill People!

According to a comment at Club Troppo, doctors are a bigger threat to community safety than guns. And, this being the internet, the commenter, Phil, had the links to prove it.

First there was this report in The National Rupert Daily, “Hospital Bungles are Killing Scores”:

AUSTRALIA’S first national report into serious mistakes in public hospitals has found at least 130 avoidable instances in which patients died or were put at serious risk.

Operations or investigations on the wrong patient, or the wrong body part, accounted for the biggest share of the mistakes, at 41 per cent of the 130 “sentinel events” recorded in 2004-05.

…

Stephen Bolsin, associate professor of patient safety at Victoria’s Geelong Hospital, said there was no evidence hospital safety had improved since a landmark 1995 report showed that up to 8per cent of hospital patients would be the victim of a preventable mistake – and 10 per cent of these would cause permanent disability or death.

“Safety breaches in Australian healthcare are killing more people than breast cancer or road accidents,” Associate Professor Bolsin said.

“But it doesn’t get anything like the attention … there’s no evidence things have changed over the past 10 years.”

I don’t know the death rate from breast cancer, but it seems to me that Professor Bolkin is indulging in hyperbole when he says that the Australian healthcare system kills more people than road accidents. A quick check of the Australian Transport Safety Bureau’s Road Deaths Australia: 2006 Statistical Summary reveals this fact:

In 2006, there were 1,601 persons killed in 1,456 road crashes. Comparing the number killed with the previous year, this was a 1.6% decrease (1,627 persons killed in 1,472 crashes).

So the comparative scores are: road traffic deaths – 1,601, patients killed or put at serious risk by the health system – 130. If Associate Professor Bolsin’s claim is correct we still have around 1,500 iatrogenic deaths to account for.

Phil’s other link is to this page at the Sporting Shooters’ Association of Australia web-site, titled “Doctors: A Health Issue”. Here you’ll find plenty of reports and links on the health risks of health care.

There are plenty of adjectives to describe this sort of reporting. “Honest” and “truthful” aren’t among them.

Finding accurate stats on iatrogenic (caused by doctors, drugs, treatments) injuries and deaths are very difficult to source. So many of the morbidity and mortality cases aren’t reported. I have unfortunately witnessed a number of people dying in hospital in this country, where misdiagnosis, incorrect treatment or poor monitoring have lead to death or medical emergencies. In none of these cases were the deaths or injuries reported as errors. Families are usually too stunned, grieving, unable to know what questions to ask or get direct answers from medical staff to realise there has been an error, let alone take action. It is not in the hospitals best interest to do so, unless they are caught out. If such stats were accurately collected I believe they would rival, if not surpass, the road toll.

Given the growing involvement of doctors in terrorism this is a frightening post! Imagine how many folk could be killed by explosives then the injured could be done away with in hospitals. It’s a double whammy!

Surely the iatrogenic deaths v car crash deaths comparison is apples and oranges? As Robert points out, most people who are in hospital in the first place are by definition already either seriously ill or seriously injured, and a large fraction of that statistic about iatrogenic deaths (inevitably very rubbery anyway, as AOF points out) would be deaths by ‘neglect’ rather than actively doing away with somebody by giving them the wrong operation or the wrong drug. I don’t think you can get any meaningful data by equating ‘violent death of healthy person in car crash’ with ‘death of ill/injured person whom doctor/hospital failed to save’.

First of all, how are the US figures relevant to Australia, Australian rates of patient deaths caused by medical errors and Australian road deaths? I hope you’re not assuming that the US statistics (or estimates in the case of deaths from medical error) can be projected to the Australian health system which is very different from the US system in the way it’s financed and managed.

Your second link also relies on a variety of estimates, from a partisan organisation that might (just might) have reason to prefer estimates at the high end of the available range. OK, so that’s, in part, an ad hom argument. But again, the figures presented are estimates.

Now let’s look to what’s reported as definite fact (in the post) – that is, results actually recorded and counted. 130 adverse events for patients in the health system – including, but not limited to, patient deaths. A death count from road accidents an order of magnitude higher. If we added in the serious and critical injuries, the figure would be higher still.

That suggests to me that The Australian’s report on the issue was a beat-up and the SSAA web-page is a beat up too. Patient deaths from medical mistakes aren’t acceptable, so I wouldn’t advocate complacency about the issue. But road traffic fatalities aren’t acceptable to me either so I’m not impressed when organisations like the SSAA, who have an obvious political agenda, start spreading misinformation. As for The Oz, the sensationalism was all about the journo getting his story in the paper.

I was surprised by the links you provided – and also disappointed. I’m not sure what you were trying to argue but you could have done it a hell of a lot better.

There was discussion of this in the Medical Journal of Australia in the early 90s, with findings that the US had much lower rates of adverse events than Australia. You can find it easily by doing a back search in the MJA, with fairly major lights in the Public Health Debate weighing in. I think you will find that after adjusting for reporting differences, Australia has a similar rate of serious death and injury, and higher rates of minor adverse effects. I don`t know if the debate was ever settled, and the hospitals were difficult to compare, so the conclusions about similar rates may not be concrete. It also doesn`t mean that the FDA`s figure applies to Australia, since it is probably calculated from much dodgier nation-wide statistics.

I’m simply pointing out that there is quite a lot of evidence to suggest medical mistakes do kill a hell of a lot of people, possibly more than much more widely-publicised things.

Furthermore, it’s easy to identify everyone who dies in a car accident. It’s not easy to identify how many people die from medical errors. So if you’re going to insist on a direct chain of evidence, you’re likely to undercount the deaths from medical errors.

Finally, one major reason why car crashes attract so much attention, compared to things like the flu that do without doubt kill similar or greater numbers of people, is that car accidents disproportionately kill young healthy adults, whereas the flu kills the already sick and elderly.

Patient deaths from medical mistakes aren’t acceptable, so I wouldn’t advocate complacency about the issue.

In fact they are acceptable. There is no choice but to accept death and no point in not accepting it. This doesn’t negate the need to try and find the reasons why the hospital death occurred and, if possible, prevent any future preventable deaths from occurring.

But patient deaths from medical mistakes are simply a predictable and not infrequent outcome of human praxis within a system that is under resourced and over-challenged, not least scientifically.

I’m going to use your comment as an excuse to make three quick points about what we now seem to be calling “adverse events”.

The first is that the medical profession is obviously aware that they occur and are prepared to discuss them (more or less) openly to get the numbers of adverse events down.

The second is that we wouldn’t be having this discussion if it weren’t for that openness.

The third is that there’s a marked contrast with the SSAA’s attitude to deaths (and injury) caused by firearms. That whole page on their site is basically about making this simple statement “You think gun-owners are bad? You should take a look at what doctors get up to!”

In fact they are acceptable. There is no choice but to accept death and no point in not accepting it. This doesn’t negate the need to try and find the reasons why the hospital death occurred and, if possible, prevent any future preventable deaths from occurring.

But patient deaths from medical mistakes are simply a predictable and not infrequent outcome of human praxis within a system that is under resourced and over-challenged, not least scientifically.

You make a good point. Complicating the stats some more, I think some highly skilled doctors could possibly have higher iatrogenic patient death rates, as they are prepared to take on difficult patients with conditions no-one else will touch, so rather than succumbing to disease, the death may be recorded as complications of surgery.

If anybody is interested in the actual “sentinel events” report, it’s here.

One notable paragraph about the statistics in the report:

The value in reporting sentinel events is not in enumerating the events and, indeed, ‘true’ rates of adverse events are unlikely to be discoverable with certainty. A traffic analogy illustrates this point. If 1000 speeding tickets were issued on one day in a city, this does not mean that only 1000 motorists were speeding on that day. Nor does it mean that twice as many motorists were speeding on that day, if 2000 tickets were issued because of a blitz on detecting speeding. The same is true of adverse event reporting.

But patient deaths from medical mistakes are simply a predictable and not infrequent outcome of human praxis within a system that is under resourced and over-challenged, not least scientifically.
MayS

Complicating the stats some more, I think some highly skilled doctors could possibly have higher iatrogenic patient death rates, as they are prepared to take on difficult patients with conditions no-one else will touch, so rather than succumbing to disease, the death may be recorded as complications of surgery.
sublime cowgirl

Gonna have to agree with those two points, and stick up for medicos here. Any comparison between recreational shooters and the medical system is utterly ridiculous and frankly offensive.

Another piece of idiocy frequently thrown about is that the death rates in hospitals go down when doctors go on strike. Well, duh. If elective procedures (at least elective in the short-term) are not being performed then the death rate will go down. For a while. But, if the doctors remain on strike, then after a while it will start rising and keep rising to way above the normal (pre-strike) levels. And the elective work not done will compound in seriousness, and be much harder (and more expensive) to fix when they do return to work.

As also pointed out by someone, the medical profession is well aware of the problem and trying to do something about it, but it is a very difficult issue and the answer does not lie entirely with them. One of the major hurdles is the very real fear of being unreasonably sued into non-practice, and the solution to that lies as much with legislators, lawyers, and the general public as with the health system itself.

Disclaimer: I am not a medico, nor their biggest fan, but know a bit more about the inside workings of medicine and medical science than your average koala.

The second is that we wouldn’t be having this discussion if it weren’t for openness [of the medical profession].

I don’t think that is right either historically or even today.

I’d say the main factors in comparative openness today are patient and family, i.e. citizenry pressure, nurses and their unions and government reponse in the form of health complaint tribunals and the like.

Mohamed Haneef was released on $10,000 bail this morning but Immigration Minister Kevin Andrews said the doctor had been taken into detention in Brisbane and will be transferred to the Villawood detention centre.

Haneef is still innocent in the eyes of the law but Mr Andrews said he was satisfied the Indian-born doctor had failed the “character test”.

Nobody told his lawyer either

Haneef’s solicitor, Peter Russo, was walking into the entrance of the Brisbane watchhouse to talk to his client about what he thought would be Haneef’s imminent release on bail when Mr Andrews called his news conference in Canberra.

Only the American Rifle Association would try out a comaprison like that. It would be equally meaningful to say that “guns don’t save lives, only doctors do”. For there to be any vaguely believeable connection you would have to compare the ratio death by medical intervention over the total number of interventions against the number of deaths by gunshot over the number of life threatening gun presentions. Passing a gun in the street will not kill a person just as passing a doctor in the street will not kill a person. There is only a risk of death for either class when there is a “confrontation” of equal gravity.

Andrews is not like sewerage, necessary but distasteful, Andrews is not necessary.
Add to this ,
Howard
Ruddock
Downer
Abbott
Brough
Nelson
Costello and on it goes.
When you think about the last eleven years, this mob really need to be made accountable for eleven years taken out of a life span of decent people. Of course when they get the flick later this year, I’m guessing November 24th they will still be leeching off us.

Well that’s got me sold. Ditch the doctor and buy a gun….two guns to be twice as safe. And for added insurance cut off HCF and stock up on L Ron Hubbard. It’s a bold new world…and a lot cheaper. Bad news Tony Abbott, you’re redundant.

âGuns are used defensively by good people 1 to 2.4 million times every year â lives saved, injuries prevented, medical costs saved, and property protectedâ¦

â¦50 to 75 lives are saved by a gun for every life lost to a gunâ?

How do we know for sure who the ‘good people’ are? Based on the figures given, perhaps the ‘study’ was simply measuring the number of US casualties versus Iraqi casualties since 2003.

Also, did the ‘study’ do a further breakdown of the results, and analysis how many ‘good people’ were saved by the defensive use of crossbows, machine guns, cannon fire, rocket launchers and flame throwers?

Maybe you should read the study to find out. Among the interesting tid-bits provided by ” Doctors for Integrity in Research & Public Policy” is this:

The victim disarmament lobby wants us to believe that it is dangerous to resist crimes like rape and assault using a gun — but USING A GUN IS ACTUALLY SAFER THAN NOT RESISTING OR RESISTING WITH LESS POWERFUL MEANS. Defense with a gun results in fewer injuries (17%) than resisting with less powerful means (knives, 40%; other weapon, 22%; physical force, 51%; evasion, 35%; etc.) and in fewer injuries than not resisting at all (25%).

When a victim is successful in repelling a crime, the victim is unlikely to report the crime, leaving police to deal only with the unsuccessful attempts to defend oneself. Since police are exposed to a skewed sample of failure, they can honestly, though incorrectly, conclude that it is dangerous to attempt to defend oneself with a gun, the so-called “Police Chief’s Fallacy” named after the former San Jose, CA Police Chief Joseph McNamara, a vocal gun prohibitionist. (emphasis added)

I think that sentence I’ve emphasised should be taken as authoritative speculation. After all, it was written by a doctor who’s for integrity in research and public policy.